頚髄に発生した脊髄硬膜下膿瘍の1例

Spinal Subdural Abscess in the Cervical Region: A Case Report

Ⅰ．はじめに

　脊髄における硬膜下膿瘍は非常に稀な病態であり，硬膜外膿瘍に比べ発生頻度は明らかに低い^12,17)．多くは発熱および背部痛にて発症するが^{3,5,11,17,18)}，神経症状を来すまで診断が確定せず治療の開始が遅れることが多々ある．過去の報告では下位胸椎あるいは上部腰椎が好発部位であるが^15,18)，われわれは頚髄に発生した硬膜下膿瘍の稀な1例を経験したので文献的考察を加え報告する．

　The authors present a patient with a spinal subdural abscess (SSA) in the cervical region and review the relevant literature. A 48-year-old man suffering from intractable high fever and back pain was admitted to our hospital with a diagnosis of meningitis. Despite antibiotic therapy, his condition deteriorated and he developed neurological deficits including left hemiparesis, sensory disturbance and bladder dysfunction. MR images of the cervical spine with gadolinium contrast revealed a circumferentially enhancing lesion anterior to the spinal cord that extended from the C4 to C6 level and compressed the spinal cord. After an urgent laminectomy extending from C4 to C6, the subdural abscess that consisted of purulent material and a thick capsule was irrigated and drained. Staphylococcus aureus was cultured from the abscess and he received antibiotic therapy postoperatively for 14 weeks. The high fever and the back pain subsided immediately and his neurologic condition gradually recovered.

　The majority of SSA cases involve the thoracic or lumbar region and are rarely found in the cervical region. Because they are associated with a high morbidity,early diagnosis with MRI and urgent surgical interventions including decompressive laminectomy,copious irrigation and drainage followed by appropriate antibiotic therapy are vital.